1871090167 NPI number — FAITH BASED COUNSELING SERVICES, LLC

Table of content: (NPI 1871090167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871090167 NPI number — FAITH BASED COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAITH BASED COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871090167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-493-6300
Provider Business Mailing Address Fax Number:
252-493-6300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 COMMERECE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-493-6300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BENBOW
Authorized Official First Name:
LA'NEIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER & CLINICAL DIRECTOR
Authorized Official Telephone Number:
252-493-6300

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  10548 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: C007676 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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